Stabbed in the Back: Confronting Back Pain in an Overtreated Society

Stabbed in the Back: Confronting Back Pain in an Overtreated Society

Stabbed in the Back: Confronting Back Pain in an Overtreated Society

Stabbed in the Back: Confronting Back Pain in an Overtreated Society


Nortin Hadler knows backaches. For more than three decades as a physician and medical researcher, he has studied the experience of low back pain in people who are otherwise healthy. Hadler terms the low back pain that everyone suffers at one time or another "regional back pain." In this book, he addresses the history and treatment of the ailment with the healthy skepticism that has become his trademark, taking the "Hadlerian" approach to backaches and the backache treatment industry in order to separate the helpful from the hype.

Basing his critique on an analysis of the most current medical literature as well as his clinical experience, Hadler argues that regional back pain is overly medicalized by doctors, surgeons, and alternative therapists who purvey various treatment regimens. Furthermore, the design of workers' compensation, disability insurance, and other "health" schemes actually thwarts getting well. For the past half century, says Hadler, back pain and back pain-related disability have exacted a huge toll, in terms of pain, suffering, and financial cost. Stabbed in the Back addresses this issue at multiple levels: as a human predicament, a profound social problem, a medical question, and a vexing public-policy challenge. Ultimately, Hadler's insights illustrate how the state of the science can and should inform the art and practice of medicine as well as public policy. Stabbed in the Back will arm any reader with the insights necessary to make informed decisions when confronting the next episode of low back pain.


Studying and understanding the clinical, social, and policy implications of low back pain have occupied most of my research efforts for over thirty years. I joined the faculty of the University of North Carolina (unc) in 1973; this was my first job after all the years of training. I was an eager clinician, educator, and investigator trained to pursue the causes of arthritis at a very basic scientific level.

Off I went to my first rheumatology clinic, proudly displaying a name tag that read “Assistant Professor of Medicine” and confident I knew all that was known about rheumatoid arthritis, lupus, scleroderma, and the other systemic diseases that are the purview of the academic rheumatologist. My first patient was a well-muscled man of forty, who appeared anxious and in some discomfort.

“Doc,” he said, “I injured my back and I don’t know if I can go to work.”

If the complaint was, “My back has been getting stiffer and stiffer since I was a teenager,” I would have been able to help him with his ankylosing spondylitis. But I had no experience or body of information to draw upon to help him with any component of his complaint — the pain in his back, the notion that his back was injured even though he couldn’t point to a particular event or accident that had caused the injury, or the perception that he was too incapacitated as a result of his back pain to continue pursuing gainful employment. I examined him, reassured him that he had suffered no major structural catastrophe, and admitted that I knew not what else to do or say. I suggested that since he had been coping for a couple of months already, he should continue to do so, and I would see him in two weeks, prepared to offer him wiser counsel.

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